Chloral hydrate

CLINICAL USE

Insomnia (short-term use)

DOSE IN NORMAL RENAL FUNCTION

Mixture: 5–20 mL at night Welldorm (707 mg): 1–2 tablets at night; maximum 2 g (5 tablets/day)Syrup: 15–45 mL at night

PHARMACOKINETICS

Molecular weight :165.4

%Protein binding :70–80

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :0.6

half-life – normal/ESRD (hrs) :7–11/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : 1 tablet at night

<10 : Avoid

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Avoid

HD :Dialysed. Avoid

HDF/high flux :Dialysed. Avoid

CAV/VVHD :Dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anticoagulants: may transiently enhance effect of coumarins

Antipsychotics: enhanced sedative effects

Antivirals: concentration possibly increased by ritonavir

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

–

Comments

Take with water (or milk) 15–30 minutes before bedtime

OTHER INFORMATION

Avoid in patients with marked hepatic or renal impairment, severe cardiac disease, marked gastritis and those susceptible to acute attacks of porphyria

Chloral hydrate followed by intravenous furosemide may result in sweating, hot flushes, and variable blood pressure including hypertension.

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